Abstract
BackgroundEnterococcus faecalis (E. faecalis) meningitis is a rare disease, and most of its occurrences are of post-operative origin. Its rapid diagnosis is critical for effective clinical management. Currently, the diagnosis is focused on cerebrospinal fluid (CSF) culture, but this is quite limited. By comparison, metagenomic next-generation sequencing (mNGS) can overcome the deficiencies of conventional diagnostic approaches. To our knowledge, mNGS analysis of the CSF in the diagnosis of E. faecalis meningitis has been not reported.Case presentationWe report the case of E. faecalis meningitis in a 70-year-old female patient without a preceding history of head injury or surgery, but with an occult sphenoid sinus bone defect. Enterococcus faecalis meningitis was diagnosed using mNGS of CSF, and she recovered satisfactorily following treatment with appropriate antibiotics and surgical repair of the skull bone defect.ConclusionsNon-post-traumatic or post-surgical E. faecalis meningitis can occur in the presence of occult defects in the cranium, and mNGS technology could be helpful in diagnosis in the absence of a positive CSF culture.
Highlights
Enterococcus faecalis (E. faecalis) meningitis is a rare disease, and most of its occurrences are of postoperative origin
Non-post-traumatic or post-surgical E. faecalis meningitis can occur in the presence of occult defects in the cranium, and metagenomic next-generation sequencing (mNGS) technology could be helpful in diagnosis in the absence of a positive cerebrospinal fluid (CSF) culture
Cerebrospinal fluid rhinorrhea or otorrhea is generally among the presenting symptoms or even a leading symptom in cases of meningitis associated with skull defects of traumatic or neurosurgical origin [5]
Summary
Non-post-traumatic or post-surgical E. faecalis meningitis can occur in the presence of occult defects in the cranium, and mNGS technology could be helpful in diagnosis in the absence of a positive CSF culture.
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